PROJECT SUMMARY Aging- and HIV-related cognitive decline of the adults in caregiving role present significant risk for functional survival (FS) among dependent African youth with and without perinatal HIV-infection. As many as 1 in 6 adolescents in some high HIV prevalence countries are affected by HIV-related parental death. These children are generally left in care of older extended family - most commonly grandparents at high risk of age-related neurocognitive decline. With strong aging demographic trends and the expansion of highly active antiretroviral therapy (HAART), the number of older adults- some with chronic HIV, in primary caregiving roles has increased dramatically. HAART has successfully prolonged life and reduced the most severe form of HAND ? i.e. HIV-associated dementia, but the prevalence of mild and asymptomatic cognitive deficits has increased in HIV-infected adults with adverse impact on their own quality of life (QOL) and critical life roles such as caregiving for dependent children. To our knowledge, the impact of caregiver HIV or age-related neurocognitive decline on caregiving quality and child wellbeing has not been investigated. Empirical data on specific areas of caregiver impairment are needed to design relevant interventions for the HIV-affected caregivers and their care recipients. The parent project evaluates Ugandan adolescents? HIV status, physiologic and psychosocial stress in relation to FS, but does not include the data on caregiver neurocognitive function and malnutrition. Malnutrition is a major driver of morbidity and mortality and represents one major pathway through which low caregiving quality impairs FS in dependent children. This supplement is designed to address the following specific aims: 1) To determine the prevalence and severity of caregiver neurocognitive decline and its predictors. 2) To determine whether caregiver?s neurocognitive decline is associated with nutritional deficits and impaired FS among dependent children/adolescents at months 0, 9, 18. 3) To determine if caregiving quality mediates the relationships in Aim 2. 4) To explore child HIV status (in the entire sample) and HAART regimen/duration (among infected adolescents) as potential modifiers of relationships specified in Aim 2. This project enhances the scientific output from parent study and will provide preliminary data to inform a future R01 study of aging and HIV-related dementia in older African?s who are aging in large numbers at marked risk for chronic HIV-infection and NCDs.